Provider Demographics
NPI:1609829746
Name:VANGSNESS, CARLETON THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLETON
Middle Name:THOMAS
Last Name:VANGSNESS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5860
Mailing Address - Fax:323-442-6296
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5314
Practice Address - Country:US
Practice Address - Phone:323-442-5860
Practice Address - Fax:323-442-6990
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56949207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G569490Medicaid
CA00G569490OtherBLUE SHIELD
CAB58008Medicare UPIN
CAG56949BMedicare ID - Type Unspecified